Surgical methods using one-way suture

ABSTRACT

Methods are disclosed for binding together human or animal tissue using one-way sutures having barbs on their exterior surfaces, allowing passage of a needle-drawn suture in one direction through tissue, but not in the opposite direction. In closing a wound, the sutures are passed through tissue at each of the opposed sides of the wound, forming suture pairs in which trailing ends of the sutures are juxtaposed in the wound. The number of suture pairs is selected in accordance with the size of the wound. The wound is closed and ends of the sutures of each suture pair are secured together, which may be by heat bonding or surgical knots. In a variation of this procedure double-armed sutures are used. In another variation detachable needles are used to leave the barbed sutures below the skin. The invention avoids loop stitching, minimizing scarring. In addition to wounds at the skin surface, the method is useful in binding together severed tendons or other internal tissue of a patient, providing considerable tensile strength with a minimum of suturing and locating the tensile support precisely where needed. In facelifts and other cosmetic operations, the sutures are used to provide lines of tissue support beneath the skin.

BACKGROUND OF THE INVENTION

The invention concerns surgical procedures, and in particular relates tosurgical methods using a one-way suture which has barb elements enablingthe suture to be pulled through tissue in one direction, but resistingmovement in the opposite direction. The methods include closing wounds,tissue support and repair of internal tissues such as tendons andligaments.

Sutures have been used in surgical procedures to close surgical andtraumatic wounds, to close the skin in plastic surgery, to securedamaged or severed tendons, muscles or other internal tissues, and inmicrosurgery on nerves and blood vessels, all for holding tissuestogether to support healing and regrowth. Such sutures are attached tothe shank end or trailing end of a needle. The sutures can be amonofilament or a braided material and many are available as a one-pieceunit pre-attached to a needle. Sutures can be of non-absorbable materialsuch as silk, nylon, polyester, polypropylene or cotton, or ofbioabsorbable material such as polymers and copolymers of glycolic andlactic acid. Loop stitching has been the primary procedure, particularlyto close a surface wound, whether an accidental or surgical wound. Suchlooped sutures, which are similar to the simplest method of seaming twopieces of fabric together, can leave ugly scars and a “Frankenstein”look to the fully healed wound. Although this can be alleviated in somecases and to some extent by using very fine suture material (e.g. 100microns in diameter), the loop stitching still can cause very visiblescars, and for adequate closure of some wounds the suture material mustbe of a high tensile strength and thus a larger diameter, increasingscarring.

Surface adhesive tapes are often used on the skin to hold small woundsclosed to permit healing, but-these have relatively low tensile strengthand are not useful in many situations. Another approach, sometimespractical, has been the use of staples for holding closed a wound forhealing. The staples have relatively high strength and save time, butare not as accurate as sutures, are bulky and painful to remove.

Surgical sutures having barbs, for providing a non-slip attribute in onedirection, are shown in U.S. Pat. No. 3,123,077. In addition, in aboutthe 1960s a metal tendon suture was produced and tried, the suturehaving a single, large barb for gripping of the tendon tissue. The metalsuture was not successful and may no longer be available, and thetechnique is outdated.

U.S. Pat. Nos. 5,425,747 and 5,584,859 disclose a type of “suture”having external barbs for holding together the two sides of an openwound. Although the theory of operation of the suture devices of thesetwo patents is similar to that of the present invention, these priorsuture devices were in essence a single relatively rigid frame. thedisclosed devices had “lateral members” with barbs, the lateral membersbeing shaped somewhat like small spears which were to be inserted intothe tissue on opposite sides of a wound, to bind the wound together. Thearrays of barbed, parallel-extending spears on both sides of the woundwere held together by a “central body member” which lay within the woundand parallel to the length of the wound and which was secured to thebarbed spears on each of the two sides. All of these components weredescribed as being of bioabsorbable material. In the '859 patent,stretchable elastic connectors secured the spear-like lateral members tothe central body member, so as to impose a tension force to pull the twosides of the wound together.

The spear-like barbed lateral members of the two described patents wererequired to be pushed into the patient's tissue, and therefore had to beof sufficient stiffness and large enough diameter such as to be capableof being pushed into the tissue. The resulting tissue securement wouldappear to be bulky and painful. The larger foreign body would tend tocause excessive scarring and would tend to increase the possibility forwound infections.

It is an object of the present invention to improve on suturingtechniques for closing wounds and severed tissues, and for performingcosmetic surgery such as face lifts, while minimizing scarring andproviding a strong retaining force between the two side of tissue.

SUMMARY OF THE INVENTION

The invention described herein includes several surgical procedures forbinding together living tissue using one-way sutures having barbs ontheir exterior surfaces and a needle on one or both ends. The one-waysutures allow passage of a needle-drawn suture in one direction throughtissue but not in the opposite direction, thus having the capability toput tension in the tissue when tension is placed on the trailing end ofthe suture.

In a procedure for closing a wound or surgical incision, the one-waysutures are passed through tissue at each of the opposed sides of thewound, forming suture pairs in which trailing ends of the sutures arepositioned generally in alignment at opposite sides of the wound. Oninsertion of each suture, the needle is pushed to extend out of theflesh at a point laterally remote from the wound, then the needle ispulled out to draw the suture to the desired position, and the suture issevered from the needle. The number of suture pairs is chosen inaccordance with the size of the wound and the strength required to holdthe wound closed.

Once all sutures are in place, the wound is closed (as by holding orclamping), and ends of the sutures of each suture pair are securedtogether, and this may be by heat bonding or surgical knots.

By the described method of using one-way sutures to hold closed a wound,loop stitching is avoided and scarring is minimized.

In addition to closing wounds at the skin surface, the method of theinvention is useful in binding together partially or completely severedtendons or other internal tissue of a patient or animal, providingconsiderable tensile strength with a minimum of suturing. The procedurelocates the tensile support precisely where it is needed.

In facelifts and other cosmetic operations, the surgeon uses the one-waysutures to provide lines of tissue support beneath the skin.

In the procedures of the invention, the sutures are hidden and may beleft in place. If desired, however, they may be formed of bioabsorbablematerial.

In a variation of the above procedure, double-armed sutures are used,with first and second surgical needles oriented in opposite directionsand a single suture extending between the shank ends of the two needles.The suture has exterior barbs oriented in one direction for about halfthe length of the suture and in the opposite direction for the otherhalf of the suture, each portion having the barbs oriented so as toallow movement along with the adjacent needle secured to the suture. Inthe double-armed suture procedure, the surgeon may fully insert one sideof the suture at one side of the wound or severed tissue, then manuallyclose the wound as he draws the opposite needle through the tissue todraw into place the other side of the suture, thus closing the wound asthe double-armed suture is fully secured in position. Both needles aresevered from the sutures at the points of exit from the tissue.

In another variation of the procedure, the surgeon can use a pull-awayneedle which is detachable from the one-way suture when the needle ispulled with sufficient tension. This enables the surgeon to leave thebarbed suture well below the skin, avoiding “puckering” of the skin fromthe pull of the barbed suture just below the skin surface. This can bedone with double-armed sutures as well.

In a facelift operation, the surgeon selects one or more paths throughthe patient's tissue where lines of tissue support are needed. Thesurgeon selects a surgical needle of sufficient length to be insertedthrough one of the selected paths in the tissue, the needle having ashank end secured to a one-way suture with exterior barbs providing forgripping of the tissue in one direction only, the direction oppositethat in which the needle is pushed through the tissue. The surgeoninserts the needle into the tissue, below the skin and along theselected path for the desired line of tissue support, until the needleextends out through the skin at a distal end of the selected path. Thenthe surgeon grips the needle from the point end and pulls it out of thetissue, leaving the one-way suture lying within the tissue along theselected path. The suture is then severed from the surgical needle, at apoint below the skin, leaving the leading end of the one-way suturehidden beneath the skin at that distal end.

The surgeon repeats the above procedure for additional lines of tissuesupport, as needed for the particular facelift operation. Once allone-way sutures are in place along the desired lines of tissue support,the surgeon applies tension to the trailing end of each suture, suchtension being in a direction opposite the direction in which the needlewas drawn, to engage the barbs against the internal tissue along thedesired lines of tissue support. The trailing end of each suture issecured in such a way that the desired line of support is placed intension. The trailing end of each suture may be secured to the patient'sadjacent tissue, or to another one-way suture which extends inessentially an opposite direction, or a double armed opposing barbedsuture can be used.

Accordingly, it is among the objects of the described invention toprovide an efficient procedure for closing wounds, incisions and severedtissue such as tendons, joint capsules and ligaments, as well as toestablish a highly efficient and invisible tissue support procedure,especially for facelift operations. These and other objects, advantagesand features of the invention will be apparent from the followingdescription of preferred embodiments, considered along with theaccompanying drawings.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a view showing a surgical needle with a one-way suture securedto the shank end of the needle, the suture including barbs on itsexterior surface.

FIG. 1A is a cross sectional view showing the suture of FIG. 1.

FIG. 2 is a cross sectional view showing a portion of a patient's skinand subcutaneous tissue, with a surgical wound or incision from the skinsurface down into the tissue, and showing the use of the needle andone-way suture of FIG. 1.

FIG. 3 is a cross sectional view of patient tissue similar to FIG. 2,but showing use of a needle and suture at both sides of the wound orincision and showing an alternate method for removing the needle fromthe suture below the skin.

FIG. 4 is another cross sectional view similar to FIG. 2, but with thesurgical needles removed and sutures severed from the needles below theskin surface and with trailing ends of the sutures extending into theopen wound.

FIG. 5 is a schematic perspective view indicating a series of one-waysutures inserted at one side of a wound, at different levels.

FIG. 5A is a plan view showing the patient's skin with the wound stillopen, and showing a series of opposed suture pairs which have been putin place by the procedure shown in FIGS. 2-4.

FIG. 6 is a cross sectional view similar to FIG. 4, but with the woundclosed and showing a knot being tied to join trailing ends of a suturedpair.

FIG. 7 is a cross sectional view similar to FIG. 6, with the woundclosed but with the suture ends being joined by a heat bondingtechnique.

FIG. 8 is an enlarged detail view showing the use of a device forperforming the heat bonding of FIG. 7.

FIG. 9 is a view showing a double-armed suture, with two needles and abarbed suture extending between the needles, the suture having twosections with oppositely-directed barbs.

FIG. 10 is a cross sectional view similar to FIGS. 6 and 7 showing asurface wound joined together with a double-armed suture such as shownin FIG. 9, the needles having been removed.

FIG. 11 is a view schematically showing a severed tendon joined togetherby one-way sutures, which in this case are shown as double-armed barbedsutures.

FIG. 12 is a schematic view indicating a facelift procedure using theone-way sutures of the invention.

FIGS. 13-18 are views showing schematically several different techniquesfor production of the one-way sutures.

DESCRIPTION OF PREFERRED EMBODIMENTS

FIG. 1 shows schematically a suture 10 secured to the trailing end 12 ofa surgical needle 14 in accordance with the invention. As describedabove, the suture 10 is a one-way suture, allowing its travel throughtissue in one direction only, toward the left as viewed in FIG. 1, dueto the presence of a multiplicity of barbs 16 on the exterior surface ofthe suture. The barbs 16 are configured to engage against a patient'stissue, much in the manner of a bee's stinger or a porcupine's quill.The surgical needle 14 is long enough to serve the type of tissue repairto be addressed, so that the needle can be completely removed, leavingthe suture in the desired position within the tissue.

FIG. 1A shows in cross section an example of one type of barbconfiguration which can be used on the sutures of the invention. Thesuture 10, which may be about 100 to 500 microns in diameter, has thebarbs 16 formed in a helical pattern; however, the barbs can also beformed in other patterns and by various means, as explained below.

FIG. 2 indicates schematically a cross section of a patient's tissue 20,showing an open wound or surgical incision 22 with sides 24 and 26. Thefigure shows surgical needles 14a and 14b which have drawn one-waysutures 10 through the tissue, to points 28, 30 of exit from the skin.The barbed, one-way sutures 10 remain in the tissue, at desiredlocations (at two different levels in the wound, in this example), withtrailing ends 10b of the sutures left extending into the wound 22.Again, the needles 14a and 14b are selected to be sufficiently long toextend through the entire path where the sutures 10 are to be placed.

In all cases the leading ends 10a of the sutures will be cut off so asto lie below the surface of the skin, which is easily accomplished bydepressing the skin immediately around the suture and severing thesuture closely against the skin, with the trailing end of the suturetensioned, then allowing the skin to cover the end of the suture.However, in many cases it is important that the skin surface not“pucker” inwardly due to tension in the suture just below the skin. Thispotential problem can be addressed in several ways. One procedure is toprovide, and to select, the proper needle and suture combination for theparticular situation to be addressed, such that the leading end 10a ofthe suture will be free of barbs in an initial region, for a selecteddistance. In FIG. 2 one of the sutures 10 is shown with a dotted line10c indicating a location where the barbs 16 commence, continuing towardthe trailing end 10b of the suture. Thus, the region between the leadingend 10a and the dashed line 10c is free of barbs, so that no tension isexerted in the tissue to pull downwardly on the skin. Another method foravoiding this potential problem, and under many circumstances the bestmethod, is to use a pull-away needle/suture combination, in which theneedle is detachable from the leading end of the suture when sufficientforce is applied. One such system is marketed as De-tach by Davis andGeck. The De-tach needle requires a pulling force equal to aboutone-third the tensile strength of the suture itself, to pull the needlefree of the suture. Such a detachable arrangement can easily be madewith the barbed sutures of the invention, such as by swaging a metal endof the needle over the leading end of the suture with just sufficientforce to allow the suture to be pulled through tissue but still allowingthe needle to be pulled free when deliberate force is applied. To usesuch a detachable needle system, the surgeon simply holds the trailingend 10b of the suture after the suture has been emplaced and pulls theneedle with the force required to detach it.

One aspect of the invention is that the detachable needle preferably hasat its base end length markings, e.g., at one centimeter intervals fromthe trailing end of the needle, to show the surgeon how far the sutureend lies beneath the skin. With reference to such markings the surgeoncan gauge the depth of the suture, predetermining the depth ofneedle-suture separation.

FIG. 3 gives a schematic indication of this procedure. A suture 10dwhich has been inserted at a lower level in the patient's tissue 20,from near the bottom of a wound 22, has been detached from a needle 14cby pulling the leading end of the needle 14c firmly while holding thetrailing end 10b of the implanted suture. As a result of this procedure,the surgeon can select a shorter suture than otherwise needed, can placethe suture 10d in a more horizontal or skin-parallel position, correctlyaligned with the desired tension to close the wound 22, and the leadingend of the suture need not be brought through or even close to the skinsurface. In addition, there is no need for a selection of needles/suturecombinations with different lengths of barb-free “blank” regions behindthe needle, as discussed relative to FIG. 2.

The sutures in FIG. 3 other than the suture 10d are not shown as havingbeen placed with detachable needles, since the figure is meant toillustrate different techniques. Normally, but not necessarily, the sameprocedure would be used for all procedures around a particular wound.

FIG. 3A shows a detachable needle 14c, with distance markings 14e at thebase end of the needle. The needle 14c is detachably secured to theleading end 10a of a one-way suture 10.

FIGS. 3 and 4 show two different stages in the procedure using theone-way sutures of the invention. FIG. 3 shows that the sutures areemplaced in pairs, so that corresponding juxtaposed sutures can beattached when the wound is to be closed, and FIG. 4 shows the sutures,in place under the skin, after removal of the needles. Once all suturepairs have been put in place, the trailing ends of the sutures will beready for attachment together with the wound 22 held closed.

FIG. 5 shows schematically, in plan view, series of suture pairs, eachpair having sutures implanted in opposite sides of the wound 22. FIG. 5shows suture pairs 32a, 32b; 34a, 34b; 36a, 36b; 38a, 38b; 40a, 40b,etc. As indicated, any number of suture pairs can be arranged for tyingor otherwise securing them together upon closure of the wound, so thatthe wound is closed successively from one end to the other and heldclosed by the connected one-way suture pairs, providing for healingwithout loop suturing at the surface.

FIG. 5A schematically shows in cross section one side of the wound orsurgical incision 22, showing trailing ends 10b of sutures extendinginto the wound, from sutures which have been pulled into position usingsurgical needles.

FIG. 6 is a schematic view showing in cross section the tying of a pairof trailing ends 10b of sutures 10 which have been placed in thepatient's tissue 20. In this case the sutures 10d are shown extending inpositions generally parallel to the surface of the skin, drawn intoposition by detachable needles such as shown and described withreference to FIG. 3. As mentioned above, the advantages of using thistype of detachable needle are (1) the suture can be kept more parallelto the skin surface, so that the tension is pulling in the mostefficient direction to close the wound; (2) the suture need not come outthrough the skin, and can be left deep beneath the skin, preventing any“puckering” of the skin; and (3) the suture can be shorter.

In FIG. 6 the suture ends 10b are tied in a knot, as the wound 22 isheld closed, and the tying and drawing of the knot tightly can actuallyhelp draw the wound closed.

However, FIGS. 7 and 8 show an alternative procedure for tying thesuture ends together, in which a heat sealing device 42 is used tosecure the suture ends together. The device 42 may be shaped generallyin the form of a pair of tweezers, with an electrical cord 44 supplyingpower to an isolated tungsten filament 46 on a first leg 47 of the tool.As can be seen in FIGS. 7 and 8, a metal tip 48 of an opposite leg 49has a recess or notch 50 which engages the two suture ends 10d. With thetwo suture ends securely engaged in this notch 50, the two legs of thetweezer-like tool are brought together and the filament 46 contacts thesuture ends and simultaneously severs the excess ends of the sutures andbonds the sutures together by fusion. The filament is heatedinstantaneously by closure of a remote switch. The blade tips 47 and 49of the instrument act as a heat sink to protect the surrounding tissue.

The surgeon will need to hold or temporarily clamp the wound 22 togetherwhile using the heat bonding tool 42. By using the tool 42 the surgeoncan quickly bond a series of suture pairs, both shallow and deep pairs,eliminating the surgical knot 41 which is left in the wound by theprocedure of FIG. 6.

FIG. 9 shows a double-armed suture 55, similar to the barbed suture 10described above but having barbs 16 oriented in one direction to oneside of a division line 56 and in the opposite direction on the otherside. As reviewed earlier, this enables the use of such one-way suturesto close and bind a wound without the need to secure suture endstogether in the wound. The double-armed suture 55 of FIG. 9 has a leftside 55a and a right side 55b.

FIG. 10 shows a wound 22 held closed by double-armed sutures 55according to procedures of the invention. The double-armed sutures 55have barb reversal points, such as shown at 56 in FIG. 9. located at orclose to the closed wound 22, such that the two sides of thedouble-armed suture each exert tension on tissue at the respective sideof the wound. The upper suture 55 in FIG. 10 is shown with cut-offleading ends 55c, which are just below the surface of the skin inaccordance with the first form of the invention described above, whereinthe sutures are severed at the skin and the skin springs back over thesevered ends 55c to cover them. However, the lower double-armed suture55 shown in FIG. 10 is shown with terminal leading ends 55c which arewell down into the tissue, far below the skin surface 58. This is merelyfor the purpose of illustration and not to suggest that the suturingprocedure should be different for the lower suture 55 than for the uppersuture 55, although this can be done. The lower suture in FIG. 10 isemplaced by the procedure shown on the lower left in FIG. 3, by apull-away needle, similar to the De-tach needle/suture combinationdescribed above, such that the suture can be drawn more horizontallythrough the tissue and can be left far below the skin. The patient'stissue is flexible and pliable, and in most cases the surgeon can insertthe needle horizontally, then make what is in effect a rather pronouncedturn with the needle up toward the surface, by manipulating the skin toangle the needle toward the surface.

The procedure for use of the double-armed sutures 55 is described above,preferably involving first inserting one end of the suture through thetissue to the position desired, with the transition point or barbreversal point 56 located in the wound; then inserting the opposedneedle of the double-armed suture into the tissue at the other side ofthe wound, and drawing this second arm of the suture tight while closingthe wound 22, to the closed position shown in FIG. 10. The needles areremoved after the suture ends are properly in place.

FIG. 11 shows double-armed sutures 60 used to repair a severed tendon62. FIG. 11 shows the use of double armed sutures, but the simplerbarbed sutures shown in FIGS. 1 through 8 could also be used. In thiscase there is no concern with “puckering” of the surface, so that theleading ends 60a of the sutures can be simply cut off at the surface ofthe tendon 62, as generally indicated in the figure. Again, if adouble-armed suture 60 is used, the point of barb direction reversalwill be located at or very close to the tendon wound 64.

FIG. 12 is a schematic illustration indicating procedures of theinvention in facelift surgery. A facelift patient 70 has a long surgicalincision 72, in which skin has been elevated in order to tighten thefacial skin, providing tissue support to remove some of the effects ofaging. The drawing indicates a series of suture pairs 73a, 73b, . . .73g, 73h and 73i, which may also be double-armed sutures as describedabove. As in the surface wound closure situations described andillustrated above, the suture pairs (or double-armed sutures) have barbsfor engaging the tissue and gripping the tissue in one direction, so asto pull the tissue toward the surgical wound 72. When each of the suturepairs or double-armed sutures 73a, 73b, etc. has been inserted and thewound has been closed at each suture, the sutures will hold and bind thewound tightly closed, without loop stitching, staples or other means,resulting in reduced scarring. The one-way sutures may be on elongatedpaths, and the sutures themselves can provide tissue support in thefacelift operation, rather than relying solely on the removal of skin atthe wound 72 for tightening of the facial tissue. FIG. 12 shows only oneexample; the one-way sutures of the invention, whether in pairs oralone, can be used in a number of different ways for tissue support. Theone-way sutures, inserted along lines beneath the skin, can support thesubcutaneous layers better than current procedures.

FIG. 13 shows schematically one method for producing one-way sutures foruse in the invention. A pair of parallel and movable bars 80, 81 havecutting blades 83 on one surface, the two sets of cutting blades beingin facing relationship and being of a size and spacing to form thesuture barbs in the size and spacing desired. The cutting blades areprecision-formed, since the raw suture 84, which may be nylon or othersuitable material, has a small diameter which may be in the range ofabout 100 to 500 microns. As an example, the barb spacings can be fromabout 100 microns to about 1 millimeter or even greater. The depth ofthe barbs formed in the suture material can be about 30 microns to 100microns, depending, to a large extent, on the diameter of the suturematerial.

As indicated in FIG. 13, the two bars 80 and 81, with the cutting blades83, are in a machine which converges them inwardly and downwardly, withreference to the figure, to engage the cutting blades into the exteriorwalls of the suture filament material 84. The suture material is heldstable during this operation, or the suture is advanced upwardly whilethe bars 80, 81 are moved only inwardly. The distance of relativelongitudinal movement between the bars and the suture will determine thedepth of the barbs formed, limited by the length of the cutting blades83 themselves.

FIG. 14 shows a resulting barbed suture 84a as produced by the deviceshown in FIG. 13. Barbs 86 are closely spaced in the suture 84a, and canbe farther apart or in different configurations if desired. As thefigure indicates, the barbs 86 are on opposite sides of the suture dueto the method of their formation, and they extend outwardly somewhat onthe suture due to the manufacturing process, wherein the cutting blades83 may be removed from the cuts by simply spreading the two bars 80 and81 (FIG. 13) outwardly, without longitudinal movement of the suturematerial 84.

FIG. 15 schematically indicates another method for forming a barbedsuture 88a from suture filament material 88 such as nylon (or othersuitable materials, including resorbable materials as discussed above).This method is somewhat similar to that of FIG. 13, but with rotatingcutting wheels 90. These cutting wheels 90 may have cutting blades 92somewhat similar to the cutting blades 83 shown in FIG. 13. In thisproduction method, the nylon suture material 88 is held with sufficienttension to cause the blades 92 of the wheels 90 to cut into the nylon,forming the barbs 94. The suture being formed nonetheless advances withthe motion of the opposed cutting wheels 90, against the imposedresistance. Again, when the cutting blades 92 are pulled free from theformed barbs 94, this pulls outwardly on each barb and causes the barbto protrude slightly from the body of the suture, setting the barbs upfor better engagement with the tissue during use.

FIG. 16 indicates a barbed suture 96 having barbs 98 in staggeredpositions. Such a suture may be formed by a method generally similar towhat is shown in FIGS. 13 and 15, but with cutting blades staggered asto height and in different positions around the periphery of the suturematerial.

FIGS. 17 and 18 indicate another system for producing barbed sutures inaccordance with the invention. FIG. 17 shows a raw suture filament 100,which may be about 100 to 500 microns in diameter, being cut into abarbed suture 102 by laser machining. As schematically indicated, alaser beam is directed at the cross hatched areas 104 in FIG. 17,removing these sections to produce barbs 106 as shown in FIG. 18. Thebarbs can be on opposed sides of the suture, as shown, and staggered ifdesired. Further, they can be positioned in a spiral pattern if desired,as by rotating the suture filament 100 or moving the laser around thefilament, during the material removal operation. Industrial lasers arecapable of being focused very sharply, easily down to the range requiredfor this laser machining operation.

Procedures described herein are useful in animal suturing as well ashuman, and the term “patient” as used in the claims should be taken asincluding application to animals.

The above described preferred embodiments are intended to illustrate theprinciples of the invention, but not to limit its scope. Otherembodiments and variations to this preferred embodiment will be apparentto those skilled in the art and may be made without departing from thespirit and scope of the invention as defined in the following claims.

I claim:
 1. A method for bringing together and holding closed an openwound in human or animal flesh to allow healing and regrowth together ofthe two sides of the wound, comprising: (a) in the open wound, insertinga surgical needle into flesh at one side of the wound, penetrating intothe flesh wall at the one side, the needle having a base or trailing endsecured to a one-way suture which has a series of exterior barbsproviding for gripping of the flesh in one direction only, the barbspermitting movement of the suture through the flesh in the direction theneedle is inserted, (b) pushing the needle to extend out of the flesh ata point laterally spaced from the wound, then gripping the needle fromthe point end and pulling the needle out of the flesh, leaving atrailing end of the suture in the open wound, (c) severing the suturefrom the needle, (d) repeating the procedure of step (a) at the oppositeside of the open wound, at a position to form a suture pair of twosutures located across the wound from one another, (e) repeating steps(b) and (c) at said opposite side of the open wound, (f) repeating steps(a) through (e) to form additional suture pairs as necessary at furtherlocations along the wound depending on the size of the wound, (g)bringing the two sides of the wound together, and (h) connectingtogether trailing ends of the two sutures of each suture pair to bindthe wound in a closed position.
 2. The method of claim 1, wherein thestep of securing together trailing ends of the sutures comprises bindingtogether the two trailing ends by means of heat fusion.
 3. The method ofclaim 2, wherein the suture is formed of nylon.
 4. The method of claim1, wherein the suture is formed of nylon.
 5. The method of claim 1,wherein the suture has a periphery and has said barbs oriented atprogressively staggered positions around the periphery of the suture. 6.The method of claim 1, wherein the surgical needle is a detachableneedle and wherein the step of severing the suture from the needlecomprises, while conducting the step of pulling the needle out of theflesh, restraining the trailing end of the suture and pulling the needlewith sufficient force to detach it from the suture at a position whereinthe leading end of the suture is well below the surface of the flesh,thereby leaving the leading end of the suture within the flesh.
 7. Themethod of claim 6, wherein the base end of the detachable needle hasmetric markings as a visual reference for a surgeon, and including thesurgeon's predetermining the depth of needle-suture severing bydetaching the needle at a desired depth by reference to the metricmarkings.
 8. The method of claim 1, wherein the suture has a leading endregion free of barbs, and wherein the step of pulling the needle out ofthe flesh comprises pulling the barb free leading end of the suture tothe flesh, leaving the barbs well below the flesh so as to avoiddownward tension at or near the surface of the skin.
 9. A surgicalmethod for bringing and holding together two tissue portions in a livingpatient or animal, to allow healing and regrowth together of the twotissue portions on either side of a tissue separation, comprising: (a)at the tissue separation, inserting a surgical needle into tissue at oneside of the separation, penetrating into the one tissue portion, theneedle having a trailing end secured to a one-way suture which has amultiplicity of exterior barbs providing for gripping of the tissue inone direction only, the barbs permitting movement of the suture throughthe tissue in the direction the needle is inserted, the surgical needlebeing a part of a double-armed suture which includes first and secondsuch surgical needles oriented in opposite directions and a singlesuture extending between the trailing ends of the two surgical needles,the suture having said exterior barbs oriented in one direction for afirst portion of the length of the suture and in the opposite directionfor a remaining, second portion of the length of the suture, eachportion having the barbs oriented so as to allow movement of thatportion of the suture through the tissue in the same direction in whichthe needle secured to that portion of the suture is inserted, (b)pushing the first surgical needle to extend along an intended line ofsupport and then out of the tissue at a point spaced from the tissueseparation, then gripping the needle from its point end and pulling theneedle out of the tissue, leaving said second portion of the sutureextending in the tissue separation, (c) repeating the procedure of step(a) at the opposite side of the open wound, using the second surgicalneedle, at a position located across the tissue separation from theposition in which the first needle was inserted, (d) repeating step (b)at said opposite side of the tissue separation, to the extent that saidsecond portion of the suture is drawn through tissue at said oppositeside of the separation, with the second surgical needle, (e) bringingthe two tissue portions together, while drawing one or both of thesurgical needles outwardly from the wound until the two portions of thesuture are located substantially in respective tissue portions atopposed sides of the separation and the suture is drawn substantiallytight so as to bind the two tissue portions together in a substantiallyclosed position, and (f) severing the suture from the two surgicalneedles.
 10. The surgical method of claim 9, wherein the surgicalneedles are detachable needles, detachable from the suture with aprescribed pulling force, and wherein the step of severing the suturefrom the two surgical needles comprises, while conducting the step ofpulling the needle out of the tissue, pulling each needle withsufficient force to detach it from the suture at a position wherein thetrailing end of the needle is well below the surface of the tissue,thereby leaving the suture well below the surface of the tissue.
 11. Thesurgical method of claim 10, wherein the two tissue portions comprisetwo sides of an open wound at the skin of a patient.
 12. The surgicalmethod of claim 9, wherein the suture is formed of nylon.
 13. Thesurgical method of claim 9, wherein the suture is formed of a resorbablematerial.
 14. The surgical method of claim 9, wherein the two tissueportions are portions of a tendon which is at least partially severed.15. The surgical method of claim 9, wherein the two tissue portionscomprise two sides of an open wound at the skin of a patient, whereinthe suture includes leading end regions free of barbs, adjacent to thetrailing end of each surgical needle, and including leaving the barbfree regions of the suture just below the skin to avoid pulling in ofthe skin.
 16. A surgical method for supporting skin and adjacentsubcutaneous tissue of a patient in a facelift operation, comprising:selecting one or more paths through the patient's facial tissue on whichlines of facial tissue support are desired, selecting a surgical needleof sufficient length to be inserted through a first of such selectedpaths in the facial tissue, the surgical needle having a trailing endsecured to a one-way suture which has a multiplicity of exterior barbsproviding for gripping of the facial tissue in one direction only, thebarbs permitting movement of the suture through the facial tissue in thedirection the needle is inserted, pushing the needle into the facialtissue, below the skin and along the selected path for the desired lineof facial tissue support, until the needle extends out through the skinat a distal end of the selected path, gripping the needle from its pointend and pulling the needle out of the patient's facial tissue, leavingthe one-way suture lying within the facial tissue along the selectedpath, severing the suture from the surgical needle, at a point below theskin, leaving a leading end of the one-way suture hidden beneath theskin at said distal end of the selected path, as needed for theparticular facelift operation, inserting a needle in additional selectedpaths for additional desired lines of facial tissue support, to placeadditional one-way sutures below the skin at said additional desiredlines of facial tissue support, applying tension to the trailing end ofeach suture, to engage the barbs against the internal tissue along saidone or more desired lines of facial tissue support, and securing thetrailing end of each suture, in the tensioned condition, such that thedesired line of support is placed in tension to provide the desiredfacial tissue support.
 17. The surgical method of claim 16, wherein thetrailing end of each suture is secured to facial tissue of the patient.18. The surgical method of claim 16, A surgical method for supportingskin and adjacent subcutaneous tissue of a patient in a faceliftoperation, comprising: selecting one or more paths through the patient'stissue on which lines of tissue support are desired, selecting asurgical needle of sufficient length to be inserted through a first ofsuch selected paths in the tissue, the surgical needle having a trailingend secured to a one-way suture which has a multiplicity of exteriorbarbs providing for gripping of the tissue in one direction only, thebarbs permitting movement of the suture through the tissue in thedirection the needle is inserted, pushing the needle into the tissue,below the skin and along the selected path for the desired line oftissue support, until the needle extends out through the skin at adistal end of the selected path, gripping the needle from its point endand pulling the needle out of the patient's tissue, leaving the one-waysuture lying within the tissue along the selected path, severing thesuture from the surgical needle, at a point below the skin, leaving aleading end of the one-way suture hidden beneath the skin at said distalend of the selected path, as needed for the particular faceliftoperation, inserting a needle in additional selected paths foradditional desired lines of tissue support, to place additional one-waysutures below the skin at said additional desired lines of tissuesupport, applying tension to the trailing end of each suture, to engagethe barbs against the internal tissue along said one or more desiredlines of tissue support, and securing the trailing end of each suture,in the tensioned condition, such that the desired line of support isplaced in tension to provide the desired tissue support, wherein thetrailing end of each suture is secured to a trailing end of anotherone-way suture which extends in essentially an opposite anotherdirection.
 19. The surgical method of claim 16, wherein the surgicalneedle is a detachable needle which detaches from the suture under aprescribed degree of pulling force, and wherein the step of severing thesutures from the surgical needle comprises, while conducting the step ofpulling the needle out of the facial tissue, restraining the trailingend of the suture and pulling the needle with sufficient force to detachit from the suture at a position wherein the trailing end of the needleis at a selected depth below the surface of the skin, thereby leavingthe suture at said selected depth.
 20. The surgical method of claim 19,wherein the surgical needle has near its trailing end metric markings asa visual reference for a surgeon, and including the surgeon'spredetermining the depth of needle-suture severing by detaching theneedle at a desired depth by reference to the metric markings.
 21. Asurgical method for bringing and holding together two tissue portions ina living patient, to allow healing and regrowth together of the twotissue portions on either side of a tissue separation, comprising: (a)at the tissue separation, inserting a surgical needle into tissue at oneside of the separation, penetrating into the one tissue portion, theneedle having a trailing end secured to a one-way suture which has amultiplicity of exterior barbs providing for gripping of the tissue inone direction only, the barbs permitting movement of the suture throughthe tissue in the direction the needle is inserted, (b) pushing theneedle to extend along an intended line of support and then out of thetissue at a point spaced from the tissue separation, then gripping theneedle from its point end and pulling the needle out of the tissue,leaving a trailing end of the suture in the tissue separation, (c)severing the suture from the needle, (d) repeating the procedure of step(a) at the opposite side of the tissue separation, in the other tissueportion, at a position to form a suture pair of two sutures locatedacross the tissue separation from one another, (e) repeating steps (b)and (c) at said opposite side of the tissue separation, in said othertissue portion, (f) repeating steps (a) through (e) to form additionalsuture pairs as necessary at further locations in the tissue separationdepending on the size of the tissue separation, (g) bringing the twotissue portions together, and (h) connecting together trailing ends ofthe two sutures of each suture pair to bind the tissue separation in aclosed position to facilitate regrowth together of the two tissueportions.
 22. The surgical method of claim 21, wherein the step ofsecuring together trailing ends of the sutures comprises bindingtogether the two trailing ends by means of heat fusion.
 23. The surgicalmethod of claim 21, wherein the two tissue portions comprise sections ofa tendon of the patient.
 24. The surgical method of claim 23, whereinthe step of securing together trailing ends of the sutures comprisesbinding together the two trailing ends by means of heat fusion.
 25. Thesurgical method of claim 21, wherein the two tissue portions comprisetwo sides of an open wound at the skin of a patient, and wherein thestep of severing the sutures comprises severing the sutures below theskin surface.
 26. The surgical method of claim 21, wherein the surgicalneedle is a detachable needle, detachable from the suture with aprescribed pulling force, and wherein the step of severing the suturefrom the surgical needle comprises, while conducting the step of pullingthe needle out of the tissue, pulling the needle with sufficient forceto detach it from the suture at a position wherein the trailing end ofthe needle is well below the surface of the tissue, thereby leaving thesuture well below the surface of the tissue.
 27. A surgical needle andsuture combination, comprising: a surgical needle, a one-way suturehaving a series of exterior barbs providing for gripping of tissue inone direction only, the barbs permitting movement of the suture throughtissue in the direction the needle is inserted, a detachable connectionmeans securing the trailing end of the needle to a leading end of thesuture, for releasing the needle from the suture when the needle pullsthe suture with a prescribed amount of tension, and the needle havingnear its trailing end metric markings as a visual reference indicatingdistance from the trailing end of the needle, whereby a surgeon canpredetermine a depth at which the needle is released from the suture byreference to the markings.
 28. The surgical method according to claim 16for supporting skin and adjacent subcutaneous tissue of a patient in afacelift operation, wherein: the one-way suture is a double-armed suturehaving a length and having barbs oriented in one direction for a firstportion of the length of the suture and in a direction opposite to theone direction for a remaining second portion of the length of thesuture.
 29. The surgical method according to claim 17 for supportingskin and adjacent subcutaneous tissue of a patient in a faceliftoperation, wherein: the one-way suture is a double-armed suture having alength and having barbs oriented in one direction for a first portion ofthe length of the suture and in a direction opposite to the onedirection for a remaining second portion of the length of the suture.30. The surgical method according to claim 19 for supporting skin andadjacent subcutaneous tissue of a patient in a facelift operation,wherein: the one-way suture is a double-armed suture having a length andhaving barbs oriented in one direction for a first portion of the lengthof the suture and in a direction opposite to the one direction for aremaining second portion of the length of the suture.
 31. The surgicalmethod according to claim 20 for supporting skin and adjacentsubcutaneous tissue of a patient in a facelift operation, wherein: theone-way suture is a double-armed suture having a length and having barbsoriented in one direction for a first portion of the length of thesuture and in a direction opposite to the one direction for a remainingsecond portion of the length of the suture.
 32. A surgical method forsupporting skin and adjacent subcutaneous tissue of a patient in afacelift operation, comprising: selecting one or more paths through thepatient's tissue on which lines of tissue support are desired, selectinga surgical needle of sufficient length to be inserted through a first ofsuch selected paths in the tissue, the surgical needle having a trailingend secured to a one-way suture which has a multiplicity of exteriorbarbs providing for gripping of the tissue in one direction only, thebarbs permitting movement of the suture through the tissue in thedirection the needle is inserted, pushing the needle into the tissue,below the skin and along the selected path for the desired line oftissue support, until the needle extends out through the skin at adistal end of the selected path, gripping the needle from its point endand pulling the needle out of the patient's tissue, leaving the one-waysuture lying within the tissue along the selected path, severing thesuture from the surgical needle, at a point below the skin, leaving aleading end of the one-way suture hidden beneath the skin at said distalend of the selected path, as needed for the particular faceliftoperation, inserting a needle in additional selected paths foradditional desired lines of tissue support, to place additional one-waysutures below the skin at said additional desired lines of tissuesupport, applying tension to the trailing end of each suture, to engagethe barbs against the internal tissue along said one or more desiredlines of tissue support, and securing the trailing end of each suture,in the tensioned condition, such that the desired line of support isplaced in tension to provide the desired tissue support for supportingskin and adjacent subcutaneous tissue of a patient in a faceliftoperation, said method further including providing tissue support in thefacelift operation from the sutures themselves.
 33. The surgical methodaccording to claim 32 for supporting skin and adjacent subcutaneoustissue of a patient in a facelift operation, said method comprising: theone-way suture being a double-armed suture having a length and havingbarbs oriented in one direction for a first portion of the length of thesuture and in a direction opposite to the one direction for a remainingsecond portion of the length of the suture.
 34. A surgical method forsupporting skin and adjacent subcutaneous tissue of a patient in afacelift operation, comprising: selecting one or more paths through thepatient's skin and adjacent subcutaneous tissue on which lines of tissuesupport are desired; selecting a first surgical needle of sufficientlength to be inserted through a first of such selected paths in thetissue, the first surgical needle having a trailing end wherein a doublearmed suture extends between and has its ends secured to the trailingends of the first surgical needle and a second such surgical needle, thetwo needles oriented in opposite directions, the suture having saidexterior barbs oriented in one direction for a first portion of thelength of the suture and in the opposite direction for a second portionof the length of the suture, each portion having the barbs oriented soas to allow movement of that portion of the suture through the tissue inthe same direction in which the needle secured to that portion of thesuture is inserted; pushing the first needle into the tissue, below theskin and along the selected path for the desired line of tissue support,until the first needle extends out through the skin at a distal end ofthe selected path; pulling the first needle out of the patient's tissue,leaving the first portion of the suture lying within the tissue alongthe selected path; as needed for the particular facelift operation,inserting the second needle in an additional selected path through thepatient's skin and adjacent subcutaneous tissue for an additionaldesired line of tissue support, to place the second portion of thesuture below the skin at said additional desired line of tissue support,until the second needle extends out through the skin at a distal end ofthe additional selected path; pulling the second needle out of thepatient's tissue, leaving the second portion of the suture lying withinthe tissue along the additional selected path; applying tension to thesuture, to engage the barbs against the internal tissue along said oneor more desired lines of tissue support, in the tensioned condition,such that the desired lines of support are placed in tension to providethe desired tissue support, and severing the suture from each needle.35. The surgical method of claim 34, wherein the surgical needles aredetachable needles which detach from the suture under a prescribeddegree of pulling force, and wherein the step of severing the suturesfrom the needles comprises, while conducting the step of pulling eachneedle out of the tissue, restraining the suture and pulling each needlewith sufficient force to detach each needle from the suture at aposition wherein the trailing end of each needle is at a selected depthbelow the surface of the skin, thereby leaving the suture at saidselected depth.
 36. The surgical method of claim 34, wherein eachsurgical needle has near its trailing end markings as a visual referencefor a surgeon, and including the surgeon's predetermining the depth ofneedle-suture severing by detaching each needle at a desired depth byreference to the markings.
 37. The method of claim 34, wherein the barbsextend outwardly somewhat on the suture.
 38. The method of claim 34,wherein the suture has said barbs at staggered positions along thesuture.
 39. The method of claim 34, wherein the suture has barbs athelical positions along the suture.
 40. The method of claim 34, whereinthe suture has barbs at opposing positions on either side along thesuture.
 41. The method of claim 34, wherein the suture is about 100 toabout 500 microns in diameter.
 42. The method of claim 34, wherein thesuture is formed of non-absorbable material.
 43. The method of claim 34,wherein the suture is formed of bioabsorbable material.
 44. A surgicalmethod for bringing and holding together two tissue portions in a livingpatient, to allow healing and regrowth together of the two tissueportions on either side of a tissue separation, comprising: (a) at thetissue separation, inserting a first surgical needle into tissue at oneside of the separation, penetrating into the one tissue portion, thefirst surgical needle having a trailing end wherein a double-armedsuture extends between and has its ends secured to the trailing ends ofthe first surgical needle and a second such surgical needle, the twoneedles oriented in opposite directions, the suture having said exteriorbarbs oriented in one direction for a first portion of the length of thesuture and in the opposite direction for a second portion of the lengthof the suture, each portion having the barbs oriented so as to allowmovement of that portion of the suture through the tissue in the samedirection in which the needle secured to that portion of the suture isinserted, (b) pushing the first needle to extend along an intended lineof support and then out of the tissue at a point spaced from the tissueseparation, then gripping the first needle from its point end andpulling the first needle out of the tissue, leaving the first portion ofthe suture in the tissue separation, (c) repeating the procedure ofsteps (a) and (b) at the opposite side of the tissue separation, in theother tissue portion, with the second needle at a position locatedacross the tissue separation, (d) repeating steps (a), (b) and (c) usingadditional double-armed sutures as necessary at further locations in thetissue separation depending on the size of the tissue separation, (e)bringing the two tissue portions together to bind the tissue separationin a closed position to facilitate regrowth together of the two tissueportions, and (f) severing the suture from each needle.
 45. The surgicalmethod of claim 44, wherein the two tissue portions comprise sections ofa tendon of the patient.
 46. The surgical method of claim 44, whereinthe two tissue portions comprise two sides of an open wound at the skinof a patient, and wherein the step of severing the sutures comprisessevering the sutures below the skin surface.
 47. The surgical method ofclaim 44, wherein each surgical needle is a detachable needle detachablefrom the suture with a prescribed pulling force, and wherein the step ofsevering the suture from each needle comprises, while conducting thestep of pulling each needle out of the tissue, pulling each needle withsufficient force to detach it from the suture at a position wherein thetrailing end of each needle is well below the surface of the tissue,thereby leaving the suture well below the surface of the tissue.
 48. Themethod of claim 44, wherein the barbs extend outwardly somewhat on thesuture.
 49. The method of claim 44, wherein the suture has said barbs atstaggered positions along the suture.
 50. The method of claim 44,wherein the suture has barbs at helical positions along the suture. 51.The method of claim 44, wherein the suture has barbs at opposingpositions on either side along the suture.
 52. The method of claim 44,wherein the suture is about 100 to about 500 microns in diameter. 53.The method of claim 44, wherein the suture is formed of non-absorbablematerial.
 54. The method of claim 44, wherein the suture is formed ofbioabsorbable material.